Major Complications of Heart Transplant Surgery

Orthotopic heart transplantation technique, since its introduction by Lower and Shumway in 1960, has been the same except for the introduction of separate caval anastomoses for the right atrium suture. Due to the relative easiness, complications directly related to the surgical technique are uncommon. In this chapter, we discuss the main complications of heart transplant surgery, trying at the same time to underline pitfalls and tips. The major complications of heart transplant surgery may be summarized as follows: (a) primary graft failure; (b) valvular incompetence for atrial wall distortion; (c) cardiac tamponade; (d) creation of a pseudo-cor-triatriatum; (e) distortion of the pulmonary trunk; (f) sinoatrial block and arrhythmias; (g) atrial thrombosis at the suture line; (h) aorta anastomosis complications; (i) mediastinitis; and (j) donor/recipient mismatch in size.